Mark Hirschbeck, a former Major League Baseball umpire, sits for a portrait next to a photograph of him taken before he worked in a World Series game, at his home in Ansonia, Connecticut, U.S., on Sunday, May 30, 2010. Displayed on the table are two World Series rings and two two All-Star Game rings Hirschbeck received while working for Major League Baseball. A failed hip replacement surgery in 2003 forced Hirschbeck into retirement. The ceramic joint made by Wright Medical Group Inc. shattered, leading to an infection and four more surgeries that left Hirschbeck permanently sidelined. Photographer: Chris Ware/Bloomberg *** Local Caption *** Mark Hirschbeck less

Mark Hirschbeck, a former Major League Baseball umpire, sits for a portrait next to a photograph of him taken before he worked in a World Series game, at his home in Ansonia, Connecticut, U.S., on Sunday, May ... more

Photo: Chris Ware, Bloomberg

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28 Oct 2001: Scott Brosius #18 of the New York Yankees argues being called out on strikes with home plate umpire Mark Hirschbeck in the eigth inning during game two against the Arizona Diamondbacks of the Major League Baseball World Series at Bank One Ballpark in Phoenix, Arizona. The Diamondbacks defeated the Yankees 4-0. DIGITAL IMAGE. Mandatory Credit: Jed Jacobsohn/ALLSPORT less

28 Oct 2001: Scott Brosius #18 of the New York Yankees argues being called out on strikes with home plate umpire Mark Hirschbeck in the eigth inning during game two against the Arizona Diamondbacks of the Major ... more

Photo: Jed Jacobsohn, Getty Images

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Mark Hirschbeck, a former Major League Baseball umpire, sits in a park near his home in Ansonia, Connecticut, U.S., on Sunday, May 30, 2010. A failed hip replacement surgery in 2003 forced Hirschbeck into retirement. The ceramic joint made by Wright Medical Group Inc. shattered, leading to an infection and four more surgeries that left Hirschbeck permanently sidelined. Photographer: Chris Ware/Bloomberg *** Local Caption *** Mark Hirschbeck less

Mark Hirschbeck, a former Major League Baseball umpire, sits in a park near his home in Ansonia, Connecticut, U.S., on Sunday, May 30, 2010. A failed hip replacement surgery in 2003 forced Hirschbeck into ... more

Photo: Chris Ware, Bloomberg

Image 4 of 5

Mark Hirschbeck, a former Major League Baseball umpire, walks in a park near his home in Ansonia, Connecticut, U.S., on Sunday, May 30, 2010. A failed hip replacement surgery in 2003 forced Hirschbeck into retirement. The ceramic joint made by Wright Medical Group Inc. shattered, leading to an infection and four more surgeries that left Hirschbeck permanently sidelined. Photographer: Chris Ware/Bloomberg *** Local Caption *** Mark Hirschbeck less

Mark Hirschbeck, a former Major League Baseball umpire, walks in a park near his home in Ansonia, Connecticut, U.S., on Sunday, May 30, 2010. A failed hip replacement surgery in 2003 forced Hirschbeck into ... more

He later learned that Wright paid tens of thousands of dollars to a foundation Keggi helps run and gave him a trip to a conference in the Bahamas. Keggi recommended the ceramic device over the kinds of implants used in 97 percent of cases.

"He was in bed with Wright and picked their product," says Hirschbeck, who is suing the company and the surgeon, alleging Wright's product was defective and Keggi failed to install it correctly. "It's disgusting it would come to that."

Wright's professional agreements with surgeons are under investigation by the Justice Department, according to filings with the Securities and Exchange Commission. It's not clear whether the payments to Keggi were improper or are being examined by prosecutors, who declined to comment.

The company and the doctor have denied the allegations in the umpire's suit.

The government declared last year that it had overhauled the financial relationships between surgeons and the biggest makers of knees and hips, saying the threat of criminal prosecution for "kickbacks" had forced them to slash payments to physicians.

The financial ties between device makers and surgeons help explain why health care costs in the U.S. rose at 2.5 times the rate of inflation in the past 10 years and account for a sixth of the economy. The $300 million works out to $300 for each of the 1 million hips and knees implanted in Americans in 2008.

Hip and knee list prices have increased 5.6 percent so far this year, on top of a 130 percent increase in the average selling price of a hip between 1996 and 2008, according to Orthopedic Network News, a trade journal that tracks costs.

In the U.S. in 2010, the average price of a primary artificial hip was $7,200, more than four times the $1,600 in Germany, says Melissa Hussey, a senior analyst on the orthopedic team at Millennium Research Group, based in Toronto. In Germany and other countries, she says, sales representatives have restricted access to surgeons.

According to government investigators, the system was perverted so that many consulting deals, royalty agreements and trips to conferences were intended not to develop better products but to persuade surgeons to use a company's products. The government charged that the industry "routinely violated the anti-kickback statute by paying physicians for the purpose of exclusively using their products."

Wright says on its website that it adheres to industry ethical standards in its dealings with consultants.

In June 2003, Hirschbeck says, a Wright salesman was in the operating theater when his ceramic hip was installed at Waterbury Hospital, which the former umpire says he was stunned to learn later.

"I didn't know this guy," he says. "What right does he have to be there?"

Hirschbeck says he knew next to nothing about artificial implants or the companies that make them. Stout, of medium height and with a fondness for flat-top haircuts, he loved being an umpire, and just wanted to find a way to do it pain-free.

He'd had his moments in the baseball sun. He umpired two World Series, including in 2001 when he became part of the story in Game 2 between the New York Yankees and the Diamondbacks. In the eighth inning, Hirschbeck called Yankees third baseman Scott Brosius out on strikes. The Yankees were being shut out. An irate Brosius was soon in Hirschbeck's face, and a photo of the confrontation ran in sports pages.

"I was about to throw him out," says Hirschbeck, whose brother John, a former Stratford resident, is still a Major League umpire. He didn't. Brosius backed off and the Yankees lost the game 4-0 and the series 4 games to 3.

"It was the most pressure I ever felt. One bad call could ruin your entire winter," he says.

After joining the major leagues following an eight-year tour in the minors, Hirschbeck was reaping the rewards. But getting into position behind home plate was starting to mean a jolt of piercing pain in his hip, he says, akin to being stabbed with a sharp knife. Cortisone shots provided temporary relief.

Then pain forced him off the field in Phoenix, and he started doing his homework on orthopedic surgeons. His choice of John Keggi, of Middlebury, was motivated not just by Keggi's reputation -- "I heard he was the best in the state," Hirschbeck says -- but also by the notion that he could recuperate close to his then-home in Shelton.

While some others recommended metal implants, Hirschbeck says Keggi pushed a new ceramic hip from Wright. "I will have you back on the field within a year," Hirschbeck says Keggi told him. Keggi, in a deposition taken in Hirschbeck's lawsuit, said he told Hirschbeck the replacement "may allow you to return to work" and that the ceramic hip "had the best chance of lasting the longest."

Less than two months after surgery, Hirschbeck was on the couch, watching TV, when he heard a pop. The pain was intense; the hip had shattered. On July 26, Keggi opened the patient up, picked out the splintered pieces and installed another ceramic implant. Within a month, Hirschbeck was back on the table.

This time, an infection had developed; Keggi washed the joint out and removed infected tissue. The pain didn't go away, Hirschbeck says, and he decided to seek out a new doctor, visiting the Hospital for Special Surgery in New York City, which performs the most replacements in the U.S.

A specialist there told Hirschbeck his hip was infected, he says, and delivered an additional jolt of bad news: Fixing the problem would mean taking out the joint and putting in a temporary spacer loaded with antibiotics. That would stay in until the infection cleared. Hirschbeck

consented.

For all of September and most of October in 2004, he lay in a hospital bed in the family room. Nurses visited daily to administer additional antibiotics. His wife emptied his bed pan. When he returned to New York in the back of his van in late October to receive yet another hip, he got a combination of components from Zimmer and Waldemar Link GmbH & Co. That operation, his fifth in 16 months, was successful.

There are an estimated 80,000 revisions of hip and knee replacements in the U.S. each year in which an artificial joint is removed because it is causing pain, became loose, failed or limits a patient's mobility, according to a study published in 2007 in the Journal of Bone & Joint Surgery.

The bill for all his repairs was $344,813, Hirschbeck says, mostly covered by workers' compensation.

In September 2005, Hirschbeck sued Keggi and Wright in Connecticut Superior Court.

Keggi's lawyer, Eugene Cooney, says in an e-mail that his client "has denied these claims and intends to fight them." The doctor declined to comment.

Officials with Wright, which has denied liability, won't answer questions about Keggi, Hirschbeck or its products while the lawsuit is pending, according to Tom McAllister, assistant general counsel for the Arlington, Tenn.-based company. It's the sixth-largest hip and knee maker, with revenue of $487.5 million last year.

Wright is "cooperating fully" with the Justice Department probe that began with a December 2007 subpoena, according to a May 5 filing with the SEC. It's "probable" there will be a settlement that may require a payment of about $8 million, the company says in the filing.

Keggi, in a deposition, said Wright had given grant money, though he didn't know how much, to the Keggi Orthopaedic Foundation, where he said he is director of research and his uncle, Kristaps Keggi, is president. "The Keggi Foundation was paid nominal sums by various product manufacturers to collect data on the results of hip replacement surgeries," Cooney says.

Keggi and his uncle, also an orthopedic surgeon, jointly owned the practice at the time of Hirschbeck's ceramic implant.

Keggi said the Wright salesman at the time for Connecticut, Scott Fitzgerald, was usually in the operating room to instruct him on installation of implants. In his deposition, Fitzgerald said that before joining Wright, he had worked

in the ski industry and sold outdoor power equipment.

Keggi no longer uses the Wright ceramic hip, having switched to a joint made by Smith & Nephew, he said in his deposition. Last year, Smith & Nephew paid Keggi $25,001 to $50,000 for consulting work and reimbursed him for $7,061 in travel and meal expenses, according to financial records posted on the company website.

In Ansonia, Hirschbeck now lives alone, collecting disability from the league, about 40 percent of his former pay. His marriage ended in divorce, partly, he says, because of the stress of his multiple surgeries.